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Bedfordshire and Luton Joint Formulary
Bedfordshire Hospitals NHS Foundation Trust
Bedfordshire, Luton and Milton Keynes ICB
Formulary Chapter: 1 - Gastro-intestinal system 
Notes:

Any drug not listed on the Formulary should be considered Non-Formulary - Not recommended for prescribing

01.07.04 Management of anal fissures

Glyceryl Trinitrate 0.4% (Rectogesic®)

First Choice

Ointment

Diltiazem 2%
(Cream, Ointment)

Second Choice

Unlicensed.

Second-line only. Restricted -  for the treatment of patients with an anal fissure resistant to topical glyceryl trinitrate 0.4% used twice daily or experiencing severe side effects (headache) from it.

Entry reviewed August 2024

Botulinum toxin type A (Botox )

RED
Restricted Drug Restricted
FOR ALL PRESCRIBING – Blueteq or High cost drug form required – see link from Formulary homepage.

100 units/vial injection

Restriction - for consultant initiation only
Must be prescribed by both GENERIC and BRAND name
Classifications
May be initiated in any care setting
Specialist to advise therapy and provide first 28 days supply, continuation in Primary Care
Specialist to initiate and stabilise medicine prior to continuation in Primary Care
To be prescribed as per Shared Care Guidance. If no SCG in place status reverts to red.
Red medicines are designated as specialist only medicines which should only be prescribed by a specialist, usually within secondary care (either due to the requirement for specialist knowledge, long-term monitoring requirements, or restrictions that mean medicine supplies are only available to hospitals).
A decision has been made either locally and/or nationally not to routinely commission this preparation. Do not prescribe.
To be purchased over the counter. May be prescribed for chronic, long term conditions or on admission to hospital if essential.